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A few years ago I got some kind of brain illness. Doctors were unable to come up with a strong diagnosis, which is apparently quite common for such cases. One

by throwaway205826 5y ago

A few years ago I got some kind of brain illness. Doctors were unable to come up with a strong diagnosis, which is apparently quite common for such cases. One of the effects of the illness was that I essentially became stupid. I couldn’t focus on anything (even trivial activities like watching television), I couldn’t compose emails, I would get disoriented easily. It was absolutely terrifying not knowing whether or not my mind would come back. At the time, I would have preferred having a disease like cancer because at least I would know what I’m dealing with. Eventually I did start to get better. Like the author, I think I’m probably not quite back to who I was before getting sick. A couple things I learned from my interaction with the medical system - 1. Like any other industry, 90% of medical “experts” are totally incompetent. 2. The state of diagnostics is pretty abysmal. So much of medicine is completely nonscientific guesswork. Most doctors aren’t even aware of the latest diagnostic developments in their own fields. Think about the people you know who learned Java in college and then never learned another programming language; chances are, your doctor is that kind of person.

hellbannedguy 5y ago
They do like mentioning The Art Of Medicine when it's not a simple ailment, or treatment failure. And I get it. It might be the only profession I know of that can still bill though. They make sure they are paid. I do get the difficulty of the profession. I know most treatments are Placebo cures. It's a weird profession. Or, we still know very little, especially ailments that affect the brain.
codingwageslave 5y ago
I’ve been trying to tell people this. It’s always met with ridicule
ashton314 5y ago
First, my sincere condolences. That is terrifying. > Think about the people you know who learned Java in college and then never learned another programming language; chances are, your doctor is that kind of person. Ooof. That is a really good analogy.
skadamou 5y ago
I'm so sorry this happened to you and I'm glad you are starting to feel at least somewhat back to your old self. I definitely understand where this opinion of docs is coming from as there are definitely some incompetent docs out there but don't you think that your opinion is largely based around an anecdotal experience that is probably pretty abnormal? Medicine as a field is still pretty unscientific in a lot of ways. To me it feels like docs are like alchemists before the discovery of the atom/modern chemistry. They're doing the best they can with the tools at hand but their field has some fundamental gaps in knowledge. Is that really the doctors fault? That's just my two cents. Obviously this doesn't do much to help folks dealing with poorly understood illnesses but I hope it helps balance out the "all doctors are idiots" opinion that sometimes comes up in threads like this.
- lrem 5y ago
  Idiots is the wrong word. They've achieved a state of the art knowledge. An idiot wouldn't get there. The problem is, most of them stopped at that. And state of the art moved on.
- throwaway205826 5y ago
  > Is that really the doctors fault? It seemed that most of the doctors I had to deal with were incompetent either because they were lazy or stupid. Realistically maybe they were just overworked, but the effect was the same. I’m not really interested in assigning “fault” here - that’s just a factual observation I made.
  - nradov 5y ago
    Are you qualified to evaluate competence in that field? What specific criteria did you use?
    - throwaway205826 5y ago
      If there were specific criteria that I could share in an HN comment, they would be used for hiring and immediately collapse under Goodhart’s law. Your question is almost tautologically bad - If I were able to answer it in a brief HN post, my answer would be bullshit. You can accurately probe competence by asking people questions about their thought process, their current hypotheses, etc. If there are $BIGNUMBER tests for competence, you only need to ask $SMALLNUMBER of them to make an accurate determination as long as the person being asked doesn’t know them ahead of time! This is the same trick many zero-knowledge proof algorithms use.
CyberDildonics 5y ago
It's amazing that you made this name and another, both posting a comment in this thread one minute after creation talking about how great this article is while lots of other people in the thread are calling it terribly written clickbait.
- ROARosen 5y ago
  ... Or maybe the commenter is not interested in announcing their medical history under their "real" (nik)name.
- throw9239393 5y ago
  I also made a throwaway account to make a comment here. I also said the article was well written. I am an HN regular, but didn't want my medical problem tied to my HN account name. Is it that odd that we might have polar opposite views on the article? Or that having a somewhat similar experience to the author, that I might view the article differently than you do?
  - CyberDildonics 5y ago
    It is odd that you would make two different names just to talk up the article, yes.
    - throw9239393 5y ago
      I'm not the other throwaway account posting here. I do have a normal HN account though.
    - dang 5y ago
      You've broken the site guidelines badly by attacking another user like that. Please review https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html and stick to the rules.
teh_infallible 5y ago
I honestly believe that the dumbest software developer is smarter than the average doctor. Look at how they prescribe drugs for the side effects of other drugs. Imagine coding a software patch to fix a bug introduced by another patch.
- DoreenMichele 5y ago
  That's at least partly about how medicine gets monetized. Imagine a world in which you got paid for patches instead of being paid by the hour. Patches on patches would likely proliferate.
- kevinmgranger 5y ago
  > Imagine coding a software patch to fix a bug introduced by another patch. This happens all the time.
- JoBrad 5y ago
  This was sarcasm, right? I’m not one of the old-timers by any stretch, but I’ve seen plenty of code that compensates for workarounds introduced by poor planning or hastily-cobbled code.
- the_af 5y ago
  > Imagine coding a software patch to fix a bug introduced by another patch. But this is very common! Far from mocking my fellow developers, I'll be the first to admit I've been guilty of this many times.
- mewpmewp2 5y ago
  What's wrong with prescribing a drug for a side effect of another drug? If you get cancer, the treatment you get can cause very many side effects which in turn can potentially be alleviated by other type of medicine. What would your suggestion be? Not to treat the patient at all?
- StavrosK 5y ago
  You have no idea how much technical debt there is in the average body. There's much more technical debt in the body than there is technology in the world. The two systems aren't remotely comparable in complexity.
thrwawy06182021 5y ago
I also am suffering from something similar. I have the working theory it's from extreme burnout but do not know for sure. I would tremendously appreciate if you shared what you found to help?
- throwaway205826 5y ago
  It’s hard to say what actually helped, but I tried a bunch of behavioral changes. Two I’ve stuck with are significantly increased exercise (half an hour plus of intense exercise every day) and a strict ketogenic diet. Even if they didn’t do anything at all for my primary condition, they’ve resulted in totally orthogonal improvements to my life. A couple months of rest (didn’t have much choice there - I couldn’t do anything else). I also used nicotine gum as a behavioral reinforcement drug to help “rehabilitate” myself on the way back to health, and THC to help me sleep. FWIW, I think it’s unlikely my problem was burnout - I had a number of viral-characteristic physiological symptoms such as digestive problems, coughing, and heart palpitations, and I would be surprised if they had a purely neurochemical cause - but in either case hopefully some of these behaviors could help.
  - thrwawy06182021 5y ago
    Thank you very very much for the tips!
cowanon22 5y ago
> Like any other industry, 90% of medical “experts” are totally incompetent. I would guess it's even worse, maybe 1-5% of doctors truly understand the underlying physiology and will holistically look at all of the information. Most doctors I've met use population heuristics and published guidelines, and if you have something rare they just throw stuff at the wall instead of trying to understand it.
- b5n 5y ago
  If you have any questions or attempt to have a discussion most doctors assume a 'where did you go to medical school' mentality, proceed to type your symptoms into an app, and then simply regurgitate the output.
- uslic001 5y ago
  As a doctor I would agree. 5% of doctors are up to date and provide high quality care. 95% are not up to date and provide low quality care. Most older doctors are grandfathered in to their specialty and do not have to take their boards but once in their life when they get out of training. So some have not taken their boards in over 30 years. Doctors in the generation after the baby boomers are not grandfathered in and have to take their boards at least every 10 years if not more often now in some specialties. So If I were you look for a doctor who graduated in 1991 or later as that is the year they stopped grandfathering. I graduated medical school in 1991. I have taken my specialty boards three times already (1997/2008/2018). Now they are moving to yearly mini-updates to stay up to date as things change too much in 10 years. None of the older doctors have to do any of this additional education and testing. They are still programming in FORTRAN.
AnIdiotOnTheNet 5y ago
> 1. Like any other industry, 90% of medical “experts” are totally incompetent. Yeah, I've come to the same conclusion. When I was a kid it took 2 years to diagnose my, frankly quite textbook, hypothyroidism. Know who first diagnosed it? A friend of my mother's who worked the toll booth at the airport. Her dog had it, you see, so she recognized the symptoms. My mother had to go full Karen mode on a doctor to get them to order the simple blood test that would confirm it.
- throwaway205826 5y ago
  Yep, if you really want someone to think hard about your condition, a hospital is the wrong place to go. And a lot of doctors will become defensive when they realize you’ve put more thought into it than they have.
- data_spy 5y ago
  Not sure if true, but whenever I've had a foreign born doctor, they tended to be better in my experience.
  - davidhyde 5y ago
    The quality of the group of doctors who emigrate from one country is not representative of the quality of all the doctors from said country. For example, it could be extremely difficult to emigrate and may require exceptional talent over peers to do so. It all depends.
- tyingq 5y ago
  Same for me. Slightly bulging neck. Itchy calves. Dry skin. Lethargy. Took years before anyone ran the relatively simple TSH test.
  - qwerty456127 5y ago
    If I were you, asking for this test would be the first thing I would say at the doctor's, explaining why I want it would be the second. Obviously most people wouldn't know they need it but IMHO this has to change. Everyone should be taught basic physiology and diagnostics at school. Every device comes with a basic manual - so every body should. I actually wonder why isn't this already the case in the USA where many people can't afford a doctor. Living some years without insurance taught me I really need to have some basic medical knowledge myself and it actually is easily available nowadays.
fellowniusmonk 5y ago
While I have no particular position, my brother is a molecular biologist and bioinformatics guy who has been published in nature, featured in NYT, etc. A true scientific nerds nerd, and he endlessly ridiculed the poor science and poor scientific understanding of people on the M.D. track that he interacted with in labs while he was doing research. I do have this anecdote from deep personal experience though... pediatric cardiologists working at research hospitals are some of the kindest, most compassionate, honest and respectful people I have met. Everyone tends to treat children with condescension and patronization (and I feel safe to extrapolate that toward their views of people in general), but those doctors seem to know that as a child you've been weighed... or maybe they just comes from a place of true compassion and pity, people underestimate the importance of compassion, kindness and listening by doctors.. especially as issues become more complex. I do think AI assistance is going to make a large difference in medical diagnostics work even if reality hasn't caught up with the hype yet.
- gwittel 5y ago
  > poor science and poor scientific understanding of people on the M.D. track Definitely a thing. At least historically, research is not a big part of a MD program in the US. MD/PhD programs are where its at -- Basically you do a few years of med school, then PhD, then finish MD. Its a very long haul. After which you usually go into Postdoc research or medical residency. The best doctor I ever had was incredibly perceptive and compassionate. What did she teach in med school? How to work with patients (i.e. bedside manner). She moved on to head palliative care, another area where empathy is key. Like any other profession doctors span a range of competency. There is an old joke: What do you call the person who finished last in medical school? Doctor.
- blablabla123 5y ago
  I remember former fellow students telling how they corrected medical students' practical physics internship assignments. Apparently the statistical rigour is much lower. On the other hand, I guess in pure natural sciences you work with much more indirection and have zero results nowadays unless you use a lot of tools. Probably there aren't that many medical conditions that can be treated in-depth based on first principles but I think concluding that whole medical science can be replaced by an AI assistant might be a bit far-fetched. Compassion is probably under-estimated indeed. Some people with serious conditions prefer to be treated at objectively less sophisticated yet less industrialized facilities.
garenp 5y ago
Was there anything you did that helped you get better?
- throwaway205826 5y ago
  Hard to say what actually helped, but two high-impact low-cost behavioral changes I made (and stuck with) were a strict ketogenic diet and regular heavy exercise (mixture of cardio and weight training). Ketogenic diet has a lot going for it - besides being a nice elimination diet (in case your problem is some kind of dietary autoimmune condition or food allergy or something), it also treats a lot of possible metabolic conditions. Exercise as well. I’m sure resting (mentally) helped but I didn’t have much choice there - resting was the only activity I could really do, and even that I couldn’t do very well.
StavrosK 5y ago
Did you also hear a sound like a bass guitar string snapping when this happened?
- throwaway205826 5y ago
  No, but this is a very interesting question. Why do you ask?
  - v0x 5y ago
    Probably a reference to this[1] although the tweet is since deleted. Basically, some guy had heard/felt a sound like a bass guitar string snapping in his head and had some pretty serious symptoms afterwards, which he thought were physiological but many commenters leaned towards some psychological issue, since the OPs explanations were somewhat nonsensical. [1] https://news.ycombinator.com/item?id=27003207 https://news.ycombinator.com/item?id=27003207
    - StavrosK 5y ago
      Yep, that's it!
rmah 5y ago
First, I'm so sorry you're going through this illness and hope that you make a full recovery. But I think that, to some degree, your feelings about the medical profession is a reflection of just how good medicine is these days. People go to the doctor expecting an accurate diagnosis and a treatment or cure. And, to be fair, 80% of the time, that's what they get. It's hard to overstate just how much of a radical shift in expectations this is. Just a century ago, a compound fracture could be a death sentence. People randomly got sick a just dropped dead. Going to a doctor might, maybe, if you were lucky, fix what ailed you. Hell, just two centuries ago, doctors as we think of them today simply did not exist. Three centuries ago, people in Europe were routinely bled to balance the humors. Biological systems are mind-numbingly complex. All the simple stuff has been figured out -- and if they are diseases mostly eradicated. Even so, I think that people's expectations of what doctors do is a bit... off. 99% of doctors are not scientists -- they are human body mechanics. And that means they mostly focus on common problems. Because, you know, they're common. And neurological conditions are some of the most difficult to diagnose. Imaging techniques like MRI or CT often show no problems. Exploratory surgery is highly risky and also usually have no benefit. To extend the mechanic analogy, imagine going to your mechanic and saying "my car's GPS system is sluggish. sometimes. What's wrong?" and then expecting them to figure out what's wrong without being able to look "under the hood" of the computer system. All they can is use the GPS system and observe its behavior. That's essentially what neurologists have to do quite often. Tough job. The good news is that there are doctors who engage in research. And they are, by trial and error, improving the state of the art of medicine. Does this knowledge get propagated to all other doctors rapidly enough? Probably not. But the knowledge dissemination is probably better today than ever before too. Obviously things can be improved. As pretty much anything can be improved. It just doesn't seem very helpful to spout "doctors are idiots" as some other posts seem to do.
dave_sid 5y ago
Hey that’s me you’re talking about! Actually I dabbled a little in Swift to maybe I’m okay.
- dave_sid 5y ago
  Wow. Marked down for a self depreciating joke. Good old HN, a jovial vortex.
temikus 5y ago
I’m sorry to hear this has happened to you and I do hope you’re only going to get better. State of diagnostics is indeed very poor, esp. in a field like Immunology. It took 2 years and 4 doctors to find what was wrong with me and how to treat it. I had to scour medical journals for treatment suggestions and then press on my doctors to try it. Sigh.
monoideism 5y ago
> . Like any other industry, 90% of medical “experts” are totally incompetent. 100% correct. I’m dealing with some serious health issues the past year (multiple worsening chronic conditions, in and out of hospital, lost 30 lbs in 3 months, etc). And yeah, the vast majority of them are idiots who know nothing more than to pull out a (often dangerous) pharma that addresses a single symptom. And forget treatment - I was just hoping for a firm diagnosis. But they hem and haw, and don’t seem at all up to date with the latest research. You’re on your own.
georgeecollins 5y ago
>> 1. Like any other industry, 90% of medical “experts” are totally incompetent. I would need data to accept this, not anecdote. There is a tendency for smart people to think they know better than experts.
- throwaway205826 5y ago
  > There is a tendency for smart people to think they know better than experts. They probably do. People hate to recognize this because it goes against most western notions of the value of work ethic, but a couple stddev of intelligence is, in many cases, more valuable than many years of experience. Sad but true.
austinvsmiami 5y ago
I had something very similar. 2 years went by where I visited over 30 doctors, and none of the public healthcare (UK) primary care and specialists had any idea what the hell was going. I took matters in my own hands, was doing blood tests by own research, googled everything I can find. Turns out I had hypogonadism, and had evidence of blood tests to prove it, and even then it took 3 more doctors to prescribe me TRT. Hope software replaces docs faster than lightning
LatteLazy 5y ago
It's not that they don't know, it's that they pretend they do, they don't want to discuss uncertainty and they dismiss when you bring it up. I'm on my 5th treatment that they're "very confident will really help a lot" but can't quite quote a percentage change of recovery for. At least that's been my experience with very similar issues. Sorry for your condition. You're not the only one in the boat. So at least we have company. I hope that helps.
secnono 5y ago
>90% of medical “experts” are totally incompetent. My wife had breast cancer, muliple lumps irregular shaped, the only answer was full mastectomy, except the oncologist wanted to do a biopsy before they did they surgery. "Why?" I asked, "You already said that the safest option is to perform the mastectomy, right?" The doctor replied, "Well, yes but we'd like to know what we are facing before we got in." Me, "Will it change what you do?" Doctor, "No" Me, "Isn't bad to poke the tumor because can't that actually cause cells to migrate?" Doctor, "yes" Me, "So what's the benefit?" Doctor, "We just want to know." Me, "It seems like either you are padding the bill or you are just following some playbook because you actually don't know what you are doing." Doctor, "We're done here." After the surgery, Doctor, "We discovered cancer cells in the lymph node, but that's probably just a side effect from the biop........" At that point he realized what he was saying and he also realized that I was ready to launch myself at him.
- catblast01 5y ago
  This story has a major plot hole. If you were so certain the biopsy was unnecessary and harmful, why didn’t you just refuse it, seek a second opinion (especially as you evidently are portraying the doctor as a villian). Also your last paragraph doesn’t even read well as preteen fall fiction.
  - jbluepolarbear 5y ago
    Doctors will refuse to do surgery if you refuse their stupid tests that don’t matter
    - scottmcf 5y ago
      Your insurance company also likely requires the test to cover the surgery.
    - catblast01 5y ago
      This is simply false.
m463 5y ago
To be honest, there are some computer problems that you really only get an inkling of when you've seen "weirdness" like that before. I remember one debugging session that I traced all over the universe, only to find it was a (kernel) stack overflow. The debugging exacerbated the problem because the debug routines ended up using more stack to log the error. The problem was strange in that it moved around and things broke that were not a problem. for reference, most operating systems have stack sizes of many megabytes for userland programs, yet kernel stack sizes are usually just kilobytes. I expect there are analogies like that with the human body, and with many more systems and with a time-critical life-and-death backdrop, I'm glad I'm not a doctor.
qwerty456127 5y ago
The symptoms sound like ADHD. Are you sure that's not the case? Have you tried sleeping more or the opposite - sleep deprivation (which can often relief ADHD) or nicotine? I have had this for my entire life and I also know a girl who got this spontaneously. Perhaps some Adderall (or a good vacation) could help.
fellellor 5y ago
Yeah. Your recovery is still not complete it seems. All the best. Eat healthy, stay occupied, and think happy thoughts.

hellbannedguy 5y ago

They do like mentioning The Art Of Medicine when it's not a simple ailment, or treatment failure. And I get it. It might be the only profession I know of that can still bill though. They make sure they are paid. I do get the difficulty of the profession. I know most treatments are Placebo cures. It's a weird profession. Or, we still know very little, especially ailments that affect the brain.

codingwageslave 5y ago

I’ve been trying to tell people this. It’s always met with ridicule

ashton314 5y ago

First, my sincere condolences. That is terrifying. > Think about the people you know who learned Java in college and then never learned another programming language; chances are, your doctor is that kind of person. Ooof. That is a really good analogy.

skadamou 5y ago

I'm so sorry this happened to you and I'm glad you are starting to feel at least somewhat back to your old self. I definitely understand where this opinion of docs is coming from as there are definitely some incompetent docs out there but don't you think that your opinion is largely based around an anecdotal experience that is probably pretty abnormal? Medicine as a field is still pretty unscientific in a lot of ways. To me it feels like docs are like alchemists before the discovery of the atom/modern chemistry. They're doing the best they can with the tools at hand but their field has some fundamental gaps in knowledge. Is that really the doctors fault? That's just my two cents. Obviously this doesn't do much to help folks dealing with poorly understood illnesses but I hope it helps balance out the "all doctors are idiots" opinion that sometimes comes up in threads like this.

lrem 5y ago
Idiots is the wrong word. They've achieved a state of the art knowledge. An idiot wouldn't get there. The problem is, most of them stopped at that. And state of the art moved on.
throwaway205826 5y ago
> Is that really the doctors fault? It seemed that most of the doctors I had to deal with were incompetent either because they were lazy or stupid. Realistically maybe they were just overworked, but the effect was the same. I’m not really interested in assigning “fault” here - that’s just a factual observation I made.
- nradov 5y ago
  Are you qualified to evaluate competence in that field? What specific criteria did you use?
  - throwaway205826 5y ago
    If there were specific criteria that I could share in an HN comment, they would be used for hiring and immediately collapse under Goodhart’s law. Your question is almost tautologically bad - If I were able to answer it in a brief HN post, my answer would be bullshit. You can accurately probe competence by asking people questions about their thought process, their current hypotheses, etc. If there are $BIGNUMBER tests for competence, you only need to ask $SMALLNUMBER of them to make an accurate determination as long as the person being asked doesn’t know them ahead of time! This is the same trick many zero-knowledge proof algorithms use.

CyberDildonics 5y ago

It's amazing that you made this name and another, both posting a comment in this thread one minute after creation talking about how great this article is while lots of other people in the thread are calling it terribly written clickbait.

ROARosen 5y ago
... Or maybe the commenter is not interested in announcing their medical history under their "real" (nik)name.
throw9239393 5y ago
I also made a throwaway account to make a comment here. I also said the article was well written. I am an HN regular, but didn't want my medical problem tied to my HN account name. Is it that odd that we might have polar opposite views on the article? Or that having a somewhat similar experience to the author, that I might view the article differently than you do?
- CyberDildonics 5y ago
  It is odd that you would make two different names just to talk up the article, yes.
  - throw9239393 5y ago
    I'm not the other throwaway account posting here. I do have a normal HN account though.
  - dang 5y ago
    You've broken the site guidelines badly by attacking another user like that. Please review https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html and stick to the rules.

teh_infallible 5y ago

I honestly believe that the dumbest software developer is smarter than the average doctor. Look at how they prescribe drugs for the side effects of other drugs. Imagine coding a software patch to fix a bug introduced by another patch.

DoreenMichele 5y ago
That's at least partly about how medicine gets monetized. Imagine a world in which you got paid for patches instead of being paid by the hour. Patches on patches would likely proliferate.
kevinmgranger 5y ago
> Imagine coding a software patch to fix a bug introduced by another patch. This happens all the time.
JoBrad 5y ago
This was sarcasm, right? I’m not one of the old-timers by any stretch, but I’ve seen plenty of code that compensates for workarounds introduced by poor planning or hastily-cobbled code.
the_af 5y ago
> Imagine coding a software patch to fix a bug introduced by another patch. But this is very common! Far from mocking my fellow developers, I'll be the first to admit I've been guilty of this many times.
mewpmewp2 5y ago
What's wrong with prescribing a drug for a side effect of another drug? If you get cancer, the treatment you get can cause very many side effects which in turn can potentially be alleviated by other type of medicine. What would your suggestion be? Not to treat the patient at all?
StavrosK 5y ago
You have no idea how much technical debt there is in the average body. There's much more technical debt in the body than there is technology in the world. The two systems aren't remotely comparable in complexity.

thrwawy06182021 5y ago

I also am suffering from something similar. I have the working theory it's from extreme burnout but do not know for sure. I would tremendously appreciate if you shared what you found to help?

throwaway205826 5y ago
It’s hard to say what actually helped, but I tried a bunch of behavioral changes. Two I’ve stuck with are significantly increased exercise (half an hour plus of intense exercise every day) and a strict ketogenic diet. Even if they didn’t do anything at all for my primary condition, they’ve resulted in totally orthogonal improvements to my life. A couple months of rest (didn’t have much choice there - I couldn’t do anything else). I also used nicotine gum as a behavioral reinforcement drug to help “rehabilitate” myself on the way back to health, and THC to help me sleep. FWIW, I think it’s unlikely my problem was burnout - I had a number of viral-characteristic physiological symptoms such as digestive problems, coughing, and heart palpitations, and I would be surprised if they had a purely neurochemical cause - but in either case hopefully some of these behaviors could help.
- thrwawy06182021 5y ago
  Thank you very very much for the tips!

cowanon22 5y ago

> Like any other industry, 90% of medical “experts” are totally incompetent. I would guess it's even worse, maybe 1-5% of doctors truly understand the underlying physiology and will holistically look at all of the information. Most doctors I've met use population heuristics and published guidelines, and if you have something rare they just throw stuff at the wall instead of trying to understand it.

b5n 5y ago
If you have any questions or attempt to have a discussion most doctors assume a 'where did you go to medical school' mentality, proceed to type your symptoms into an app, and then simply regurgitate the output.
uslic001 5y ago
As a doctor I would agree. 5% of doctors are up to date and provide high quality care. 95% are not up to date and provide low quality care. Most older doctors are grandfathered in to their specialty and do not have to take their boards but once in their life when they get out of training. So some have not taken their boards in over 30 years. Doctors in the generation after the baby boomers are not grandfathered in and have to take their boards at least every 10 years if not more often now in some specialties. So If I were you look for a doctor who graduated in 1991 or later as that is the year they stopped grandfathering. I graduated medical school in 1991. I have taken my specialty boards three times already (1997/2008/2018). Now they are moving to yearly mini-updates to stay up to date as things change too much in 10 years. None of the older doctors have to do any of this additional education and testing. They are still programming in FORTRAN.

AnIdiotOnTheNet 5y ago

> 1. Like any other industry, 90% of medical “experts” are totally incompetent. Yeah, I've come to the same conclusion. When I was a kid it took 2 years to diagnose my, frankly quite textbook, hypothyroidism. Know who first diagnosed it? A friend of my mother's who worked the toll booth at the airport. Her dog had it, you see, so she recognized the symptoms. My mother had to go full Karen mode on a doctor to get them to order the simple blood test that would confirm it.

throwaway205826 5y ago
Yep, if you really want someone to think hard about your condition, a hospital is the wrong place to go. And a lot of doctors will become defensive when they realize you’ve put more thought into it than they have.
data_spy 5y ago
Not sure if true, but whenever I've had a foreign born doctor, they tended to be better in my experience.
- davidhyde 5y ago
  The quality of the group of doctors who emigrate from one country is not representative of the quality of all the doctors from said country. For example, it could be extremely difficult to emigrate and may require exceptional talent over peers to do so. It all depends.
tyingq 5y ago
Same for me. Slightly bulging neck. Itchy calves. Dry skin. Lethargy. Took years before anyone ran the relatively simple TSH test.
- qwerty456127 5y ago
  If I were you, asking for this test would be the first thing I would say at the doctor's, explaining why I want it would be the second. Obviously most people wouldn't know they need it but IMHO this has to change. Everyone should be taught basic physiology and diagnostics at school. Every device comes with a basic manual - so every body should. I actually wonder why isn't this already the case in the USA where many people can't afford a doctor. Living some years without insurance taught me I really need to have some basic medical knowledge myself and it actually is easily available nowadays.

fellowniusmonk 5y ago

While I have no particular position, my brother is a molecular biologist and bioinformatics guy who has been published in nature, featured in NYT, etc. A true scientific nerds nerd, and he endlessly ridiculed the poor science and poor scientific understanding of people on the M.D. track that he interacted with in labs while he was doing research. I do have this anecdote from deep personal experience though... pediatric cardiologists working at research hospitals are some of the kindest, most compassionate, honest and respectful people I have met. Everyone tends to treat children with condescension and patronization (and I feel safe to extrapolate that toward their views of people in general), but those doctors seem to know that as a child you've been weighed... or maybe they just comes from a place of true compassion and pity, people underestimate the importance of compassion, kindness and listening by doctors.. especially as issues become more complex. I do think AI assistance is going to make a large difference in medical diagnostics work even if reality hasn't caught up with the hype yet.

gwittel 5y ago
> poor science and poor scientific understanding of people on the M.D. track Definitely a thing. At least historically, research is not a big part of a MD program in the US. MD/PhD programs are where its at -- Basically you do a few years of med school, then PhD, then finish MD. Its a very long haul. After which you usually go into Postdoc research or medical residency. The best doctor I ever had was incredibly perceptive and compassionate. What did she teach in med school? How to work with patients (i.e. bedside manner). She moved on to head palliative care, another area where empathy is key. Like any other profession doctors span a range of competency. There is an old joke: What do you call the person who finished last in medical school? Doctor.
blablabla123 5y ago
I remember former fellow students telling how they corrected medical students' practical physics internship assignments. Apparently the statistical rigour is much lower. On the other hand, I guess in pure natural sciences you work with much more indirection and have zero results nowadays unless you use a lot of tools. Probably there aren't that many medical conditions that can be treated in-depth based on first principles but I think concluding that whole medical science can be replaced by an AI assistant might be a bit far-fetched. Compassion is probably under-estimated indeed. Some people with serious conditions prefer to be treated at objectively less sophisticated yet less industrialized facilities.

garenp 5y ago

Was there anything you did that helped you get better?

throwaway205826 5y ago
Hard to say what actually helped, but two high-impact low-cost behavioral changes I made (and stuck with) were a strict ketogenic diet and regular heavy exercise (mixture of cardio and weight training). Ketogenic diet has a lot going for it - besides being a nice elimination diet (in case your problem is some kind of dietary autoimmune condition or food allergy or something), it also treats a lot of possible metabolic conditions. Exercise as well. I’m sure resting (mentally) helped but I didn’t have much choice there - resting was the only activity I could really do, and even that I couldn’t do very well.

StavrosK 5y ago

Did you also hear a sound like a bass guitar string snapping when this happened?

throwaway205826 5y ago
No, but this is a very interesting question. Why do you ask?
- v0x 5y ago
  Probably a reference to this[1] although the tweet is since deleted. Basically, some guy had heard/felt a sound like a bass guitar string snapping in his head and had some pretty serious symptoms afterwards, which he thought were physiological but many commenters leaned towards some psychological issue, since the OPs explanations were somewhat nonsensical. [1] https://news.ycombinator.com/item?id=27003207 https://news.ycombinator.com/item?id=27003207
  - StavrosK 5y ago
    Yep, that's it!

rmah 5y ago

First, I'm so sorry you're going through this illness and hope that you make a full recovery. But I think that, to some degree, your feelings about the medical profession is a reflection of just how good medicine is these days. People go to the doctor expecting an accurate diagnosis and a treatment or cure. And, to be fair, 80% of the time, that's what they get. It's hard to overstate just how much of a radical shift in expectations this is. Just a century ago, a compound fracture could be a death sentence. People randomly got sick a just dropped dead. Going to a doctor might, maybe, if you were lucky, fix what ailed you. Hell, just two centuries ago, doctors as we think of them today simply did not exist. Three centuries ago, people in Europe were routinely bled to balance the humors. Biological systems are mind-numbingly complex. All the simple stuff has been figured out -- and if they are diseases mostly eradicated. Even so, I think that people's expectations of what doctors do is a bit... off. 99% of doctors are not scientists -- they are human body mechanics. And that means they mostly focus on common problems. Because, you know, they're common. And neurological conditions are some of the most difficult to diagnose. Imaging techniques like MRI or CT often show no problems. Exploratory surgery is highly risky and also usually have no benefit. To extend the mechanic analogy, imagine going to your mechanic and saying "my car's GPS system is sluggish. sometimes. What's wrong?" and then expecting them to figure out what's wrong without being able to look "under the hood" of the computer system. All they can is use the GPS system and observe its behavior. That's essentially what neurologists have to do quite often. Tough job. The good news is that there are doctors who engage in research. And they are, by trial and error, improving the state of the art of medicine. Does this knowledge get propagated to all other doctors rapidly enough? Probably not. But the knowledge dissemination is probably better today than ever before too. Obviously things can be improved. As pretty much anything can be improved. It just doesn't seem very helpful to spout "doctors are idiots" as some other posts seem to do.

dave_sid 5y ago

Hey that’s me you’re talking about! Actually I dabbled a little in Swift to maybe I’m okay.

dave_sid 5y ago
Wow. Marked down for a self depreciating joke. Good old HN, a jovial vortex.

temikus 5y ago

I’m sorry to hear this has happened to you and I do hope you’re only going to get better. State of diagnostics is indeed very poor, esp. in a field like Immunology. It took 2 years and 4 doctors to find what was wrong with me and how to treat it. I had to scour medical journals for treatment suggestions and then press on my doctors to try it. Sigh.

monoideism 5y ago

> . Like any other industry, 90% of medical “experts” are totally incompetent. 100% correct. I’m dealing with some serious health issues the past year (multiple worsening chronic conditions, in and out of hospital, lost 30 lbs in 3 months, etc). And yeah, the vast majority of them are idiots who know nothing more than to pull out a (often dangerous) pharma that addresses a single symptom. And forget treatment - I was just hoping for a firm diagnosis. But they hem and haw, and don’t seem at all up to date with the latest research. You’re on your own.

georgeecollins 5y ago

>> 1. Like any other industry, 90% of medical “experts” are totally incompetent. I would need data to accept this, not anecdote. There is a tendency for smart people to think they know better than experts.

throwaway205826 5y ago
> There is a tendency for smart people to think they know better than experts. They probably do. People hate to recognize this because it goes against most western notions of the value of work ethic, but a couple stddev of intelligence is, in many cases, more valuable than many years of experience. Sad but true.

austinvsmiami 5y ago

I had something very similar. 2 years went by where I visited over 30 doctors, and none of the public healthcare (UK) primary care and specialists had any idea what the hell was going. I took matters in my own hands, was doing blood tests by own research, googled everything I can find. Turns out I had hypogonadism, and had evidence of blood tests to prove it, and even then it took 3 more doctors to prescribe me TRT. Hope software replaces docs faster than lightning

LatteLazy 5y ago

It's not that they don't know, it's that they pretend they do, they don't want to discuss uncertainty and they dismiss when you bring it up. I'm on my 5th treatment that they're "very confident will really help a lot" but can't quite quote a percentage change of recovery for. At least that's been my experience with very similar issues. Sorry for your condition. You're not the only one in the boat. So at least we have company. I hope that helps.

secnono 5y ago

>90% of medical “experts” are totally incompetent. My wife had breast cancer, muliple lumps irregular shaped, the only answer was full mastectomy, except the oncologist wanted to do a biopsy before they did they surgery. "Why?" I asked, "You already said that the safest option is to perform the mastectomy, right?" The doctor replied, "Well, yes but we'd like to know what we are facing before we got in." Me, "Will it change what you do?" Doctor, "No" Me, "Isn't bad to poke the tumor because can't that actually cause cells to migrate?" Doctor, "yes" Me, "So what's the benefit?" Doctor, "We just want to know." Me, "It seems like either you are padding the bill or you are just following some playbook because you actually don't know what you are doing." Doctor, "We're done here." After the surgery, Doctor, "We discovered cancer cells in the lymph node, but that's probably just a side effect from the biop........" At that point he realized what he was saying and he also realized that I was ready to launch myself at him.

catblast01 5y ago
This story has a major plot hole. If you were so certain the biopsy was unnecessary and harmful, why didn’t you just refuse it, seek a second opinion (especially as you evidently are portraying the doctor as a villian). Also your last paragraph doesn’t even read well as preteen fall fiction.
- jbluepolarbear 5y ago
  Doctors will refuse to do surgery if you refuse their stupid tests that don’t matter
  - scottmcf 5y ago
    Your insurance company also likely requires the test to cover the surgery.
  - catblast01 5y ago
    This is simply false.

m463 5y ago

To be honest, there are some computer problems that you really only get an inkling of when you've seen "weirdness" like that before. I remember one debugging session that I traced all over the universe, only to find it was a (kernel) stack overflow. The debugging exacerbated the problem because the debug routines ended up using more stack to log the error. The problem was strange in that it moved around and things broke that were not a problem. for reference, most operating systems have stack sizes of many megabytes for userland programs, yet kernel stack sizes are usually just kilobytes. I expect there are analogies like that with the human body, and with many more systems and with a time-critical life-and-death backdrop, I'm glad I'm not a doctor.

qwerty456127 5y ago

The symptoms sound like ADHD. Are you sure that's not the case? Have you tried sleeping more or the opposite - sleep deprivation (which can often relief ADHD) or nicotine? I have had this for my entire life and I also know a girl who got this spontaneously. Perhaps some Adderall (or a good vacation) could help.

fellellor 5y ago

Yeah. Your recovery is still not complete it seems. All the best. Eat healthy, stay occupied, and think happy thoughts.